Healthcare Provider Details

I. General information

NPI: 1114553013
Provider Name (Legal Business Name): CARMEN RAE HOLMES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARMEN RAE BOESSEN

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 1ST ST SW
ROCHESTER MN
55905-0001
US

IV. Provider business mailing address

PO BOX 860912
MINNEAPOLIS MN
55486-0912
US

V. Phone/Fax

Practice location:
  • Phone: 507-284-2511
  • Fax:
Mailing address:
  • Phone: 507-284-2511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number70002
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME168795
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License Number70002
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: